Effectiveness of near-infrared spectroscopy to predict the chemical composition of feces and total-tract apparent nutrients digestibility estimated with uNDF or AIA in lactating buffaloes' feces

Following a comparison of nutrient total-tract digestibility estimates in lactating buffaloes using single-point undigestible NDF (uNDF) or acid-insoluble ash (AIA) as internal markers, the potential of fecal near-infrared spectroscopy (NIRS) to provide calibration equations for the assessment of the chemical composition of feces and nutrient total-tract digestibility estimated with internal markers was explored. Chemical analyses were performed on 147 fecal samples from lactating buffaloes reared in 5 farms in central Italy (Naples). Each farm fed a silage-based total mixed ration (TMR) to the buffaloes, which was sampled in the 2 d before the fecal collection. The TMR and individual fecal samples were collected and analyzed for dry matter (DM), organic matter (OM), ash, AIA, ether extract (EE), starch, fiber fractions (aNDFom, aNDF, ADFom, ADF, hemicellulose, cellulose, ADL, uNDF), N, CP and CP bound to aNDF (NDICP) and to ADF (ADICP). The uNDF content was determined through a 240-h in vitro fermentation and employed, together with AIA as markers to estimate the total-tract apparent digestibility (ttaDe) and total-tract digestibility (ttDe) of DM, OM, ash, N, CP, EE, aNDFom, aNDF, NDIP, ADFom and ADF, ADIN, ADL, hemicellulose, cellulose, starch, non-fibrous carbohydrates (NFC) and fraction B3 of N. No correlation was found between DM and OM digestibility estimated with AIA and uNDF as internal markers. Weak correlations were detected for all the other nutients digestibilities while strong correlations were observed for EE, ADFom, HC, NDIN, ADIN, NB3, NFC and starch.Inizio modulo The sample set (n = 147) was divided in a calibration set (n = 111) and a validation set (n = 36) to "train" and "validate" the fecal NIRS curve through an external validation process. An estimation usable for preliminary or initial evaluation was obtained for N, CP and aNDF fecal content. An excellent prediction was obtained for ttADINDe (R2 = 0.90) when estimated with uNDF as internal marker. The NIRS technology was not able to accurately predict all the other traits and the estimated nutrient digestibility of lactating buffalo diets from fecal spectra.

Using a food web model to predict the effects of Hazardous and Noxious Substances (HNS) accidental spills on deep-sea hydrothermal vents from the Mid-Atlantic Ridge (MAR) region

Deep-sea hydrothermal vents host unique ecosystems but face risks of incidents with Hazardous and Noxious Substances (HNS) along busy shipping lanes such as the transatlantic route. We developed an Ecopath with Ecosim (EwE) model of the Menez Gwen (MG) vent field (MG-EwE) (Mid-Atlantic Ridge) to simulate ecosystem effects of potential accidental spills of four different HNS, using a semi-Lagrangian Dispersion Model (sLDM) coupled with the Regional Ocean Modelling System (ROMS) calibrated for the study area. Food web modelling revealed a simplified trophic structure with low energy efficiency. The MG ecosystem was vulnerable to disruptions caused by all tested HNS, yet it revealed some long-term resilience. Understanding these impacts is vital for enhancing Spill Prevention, Control, and Countermeasure plans (SPCC) in remote marine areas and developing tools to assess stressors effects on these invaluable habitats.

Metastasis Models: Thermodynamics and Complexity

The thermodynamic formalism of nonequilibrium systems together with the theory of complex systems and systems biology offer an appropriate theoretical framework to explain the complexity observed at the macroscopic level in physiological phenomena. In turn, they allow the establishment of an appropriate conceptual and operational framework to address the study of phenomena such as the emergence and evolution of cancer.This chapter is organized as follows: In Subheading 1, an integrated vision of these disciplines is offered for the characterization of the emergence and evolution of cancer, seen as a nonlinear dynamic system, temporally and spatially self-organized out of thermodynamic equilibrium. The development of the various mathematical models and different techniques and approaches used in the characterization of cancer metastasis is presented in Subheading 2. Subheading 3 is devoted to the time course of cancer metastasis, with particular emphasis on the epithelial-mesenchymal transition (EMT henceforth) as well as chronotherapeutic treatments. In Subheading 4, models of the spatial evolution of cancer metastasis are presented. Finally, in Subheading 5, some conclusions and remarks are presented.

The Effect of Ethanol Associated with Universal Adhesive on Resin Composite Adhesion to Different Dentin Depths: A Long-Term In Vitro Study

To evaluate the ethanol wet-bonding protocol with a universal adhesive in etch-andrinse and self-etch modes on microleakage and microtensile bond strength (μTBS) of resin composite to different dentin depth. Molars were distributed into groups according to protocol and dentin depth: universal adhesive (C - control), ethanol + universal adhesive (E), and phosphoric acid etch + ethanol + universal adhesive (PA+E). All protocols were applied to dentin at superficial, middle and deep depths. The specimens (n = 10) were submitted to microleakage and μTBS tests. Half of specimens were submitted to thermocycling (10,000 cycles; 5∘C/55∘C). Data were submitted to Spearman correlation (μTBS x microleakage) and three-way ANOVA (protocol, aging and depth), followed by Bonferroni post hoc test (α=0.05). PA+E group showed highest μTBS and lowest microleakage mean values in 24h. All groups presented similar μTBS mean values after thermocycling. The deep dentin showed less stable μTBS results. PA+E group presented highest microleakage mean values after thermocycling. Spearman's correlation showed a strong correlation between microleakage and μTBS. The PA+E group improved immediate adhesion and E group promoted a more stable μTBS in the long-term adhesion of universal adhesive. The aging for all protocols jeopardized the stability of the hybrid layer. The ethanol wet bonding technique associated with universal adhesive has enhanced the immediate result of the resin composite adhesion.

Priority setting for restoration in surrounding savannic areas of the Brazilian Pantanal based on soil loss risk and agrarian structure

Soil health is at the core of the sustainability agenda. As in many agroecosystems in the tropics, soil erosion is a major issue in poorly managed pasturelands. A noteworthy case is located in the Upper Taquari River Basin (UTRB), as part of the Upper Paraguay Basin on the plateau with drainage waters for the Taquari megafan in the Brazilian Pantanal. Here we combine slope (S-factor), erodibility (E-factor), rainfall-rainy day ratio (R-factor), and vegetation and soil indices (C-factor) to locate erosion risk and prioritize eco-engineering interventions via palisades and small dams in UTRB. The method consisted of assessing distinct weights between Universal Soil Loss Equation (USLE) factors in a GIS platform, providing 35 combinations of classes as low, moderate, high, and very high erosive risk. The validation of the method was based on the ravine and plain ground truths obtained from high-resolution raster data. The best weight of USLE factors aids to locate critical erosive sites and vegetation patterns. Then, erosion risk and interventions were analyzed according to land use and rural property sizes in the government's Rural Environmental Registry (CAR) database. Overall, the natural factors of slope and erodibility in a proportion of 25% and 75% in GIS algebra provided the best mapping accuracy result. About 65% of the UTRB has high or very high erosion risks, and 70% of the available area can be acknowledged as degraded pasturelands. A total of 4744 erosion interventions were recorded, with an accuracy of 65.28% and 61.15% for check dams and palisades interventions, respectively. The number of necessary interventions in areas of native vegetation was almost 50% higher than in pasturelands. Even though micro landowners occupy most of the watershed, large properties have about ten times as many areas at high risk of erosion. The mutual cooperation between properties, independently of size, is supported by governmental public policies like incentives for ecosystem services restoration of critical gullies, with CAR compliance and fiscalization.

P396 OUR CERTIFIED SYNCOPE UNIT EXPERIENCE; FROM DIAGNOSTIC APPROPRIATENESS TO DEVICE IMPLANTS, FROM PATIENT EDUCATION TO THE IMPACT OF THE COVID–19 PANDEMIC. REPORT ON TWO “DIFFICULT” YEARS

Syncope is a frequent medical problem with an incidence of about 6.2/1000 people/year, with important impact on the patients quality of life and often difficult to diagnose and manage; in this regard, the Syncope Units certified by the Italian Group for the study of syncope were created. The following describes our experience over the last 30 months characterized by significant difficulties due to the COVID–19 pandemic. Our Syncope Unit, included in the OU of Cardiology, includes 3 doctors, 3 cardiology technicians, 2 nurses; the activity is three times a week in terms of clinic and HUTT (Head up tilt test). In 2019, 54 HUTTs were performed on patients with an average age of 67 years 50% male, with indication of vasovagal syncope (VVS) for 78% of cases, presyncope and other indications for the remaining 21%, requested by other services. The HUTT was positive for cardioinhibitory and sinus–carotid syncope with indication for Pacemaker implantation (with closed loop stimulation algorithm – CLS) for 22% of cases. In 12% of patients, an ECG–Loop recorder (ILR) was indicated, but 42% of these refused this procedure. In 2020, 32 HUTTs were performed, the same average age, with 86% indication of VVS syncope. The indication for a pacemaker implant was 15% as well as for an ILR implant. 33 to 38% of patients were educated, providing dedicated material, on the prevention of syncope. About 4% of patients refused to undergo the HUTT after the explanation of its performing modalities. The first 6 months of 2021 showed a similar trend to that of 2019. The data show a good appropriateness of the indications to the HUTT and a subsequent PM implantation rate similar to the data available in the literature. The device with CLS has shown benefits in reducing syncopal recurrences at 6 months by over 25%; only 3% of the ILRs were followed by PM implantation. The HUTT, despite of low sensitivity and specificity, is confirmed as a valid VVS characterization tool but sometimes the patient frightened by its performing methods. The COVID–19 pandemic significantly impacted our activity, related to the outpatient in office activities stop and to the shift of operators in COVID areas. We had a 40% reduction in visits and HUTTs performed with consequent missed and/or delayed diagnoses.

Life-history data of a key amphipod species from three NE Atlantic estuaries under different levels of anthropogenic pressure

Knowledge on population dynamics of ecosystem's key-species is invaluable to understand how populations will respond to natural and human-induced perturbations. The amphipod Echinogammarus marinus is a key-species from European estuarine habitats with a distribution ranging from Norway to Portugal [1]. The present article contains supportive data related to a research article entitled ‘Comparing production and life-history traits of a key amphipod species within and between estuaries under different levels of anthropogenic pressure’ [2]. The present dataset presents the density, biomass, fecundity, and production of E. marinus in three estuaries under different anthropogenic pressure and, within each estuary, at three sampling sites, which differed in terms of the distance to the estuary mouth, vegetation cover, and organic matter content. Monthly environmental abiotic data and seasonal concentration of PAH and other contaminants are also provided. Sampling took place monthly for 13 months at low tide on intertidal mudflats. At each site, Fucus fronds containing E. marinus individuals were randomly collected. All E. marinus individuals were counted, sexed, and measured under a binocular stereo microscope to estimate the density and the biomass of E. marinus in Fucus fronds. Finally, the annual production of E. marinus at each sampling site was estimated through the size-frequency method. This dataset may be used to compare population traits of E. marinus populations across different estuaries and it may overall assist designing studies regarding population dynamics and designing management strategies in coastal systems, namely targeting at habitat conservation and restoration.

Comparing production and life-history traits of a key amphipod species within and between estuaries under different levels of anthropogenic pressure

Inter-population variability may arise as a response to adverse natural and anthropogenic stressors. The dynamics of a key amphipod species (Echinogammarus marinus) was followed during ≈ 1-year at its southerly range (NW Portugal), in three estuaries with different levels of anthropogenic pressure (High - Ave estuary; Moderate - Mondego estuary; Low - Minho estuary). We hypothesised that E. marinus populations would present lower production and fitness, and higher intersexuality incidence with increasing anthropogenic pressure. According to a GAM model explaining ≈70% of the observed variability, E. marinus biomass depends on temperature, organic matter, Fucus area and time of the year. Significant differences were found between the gammarid biomass in Minho and Mondego estuaries and within sites from the same estuary. As expected, Ave estuary exhibited the lowest average annual production, abundance and fecundity rates. However, the highest average production was found in Mondego and not in Minho estuary, although the turnover ratio (P/B) of both estuaries was very similar. Besides the system's global ecological status, E. marinus also seems to respond to microhabitat conditions, which may explain the spatial heterogeneity observed in the amphipod production within the same estuary. Intersexuality prevalence was negligible in the three populations, which does not support the idea of a link between anthropogenic pressure and intersexuality in E. marinus. We argue that the dependence of E. marinus on Fucus sp. should be further investigated to fully understand the role of both fucoids and the gammarid in coastal foodwebs.

Practical application of synthetic head models in real ballistic cases

In shooting crimes, ballistics tests are often recommended in order to reproduce the wound characteristics of the involved persons. For this purpose, several "simulants" can be used. However, despite the efforts in the research of "surrogates" in the field of forensic ballistic, the development of synthetic models needs still to be improved through a validation process based on specific real caseworks. This study has been triggered by the findings observed during the autopsy performed on two victims killed in the same shooting incident, with similar wounding characteristics; namely two retained head shots with ricochet against the interior wall of the skull; both projectiles have been recovered during the autopsies after migration in the brain parenchyma. The thickness of the different tissues and structures along the bullets trajectories as well as the incident angles between the bullets paths and the skull walls have been measured and reproduced during the assemblage of the synthetic head models. Two different types of models ("open shape" and "spherical") have been assembled using leather, polyurethane and gelatine to simulate respectively skin, bone and soft tissues. Six shots have been performed in total. The results of the models have been compared to the findings of post-mortem computed tomography (PMCT) and the autopsy findings.Out of the six shots, two perforated the models and four were retained. When the projectile was retained, the use of both models allowed reproducing the wounds characteristics observed on both victims in terms of penetration and ricochet behaviour. However, the projectiles recovered from the models showed less deformation than the bullets collected during the autopsies. The "open shape" model allowed a better controlling on the shooting parameters than the "spherical" model. Finally, the difference in bullet deformation could be caused by the choice of the bone simulant, which might under-represent either the strength or the density of the human bone. In our opinion, it would be worth to develop a new, more representative material for ballistic which simulates the human bone.

Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression

OBJECTIVE

New antidepressant treatments are needed that are effective, rapid acting, safe, and tolerable. Intermittent theta-burst stimulation (iTBS) is a noninvasive brain stimulation treatment that has been approved by the U.S. Food and Drug Administration for treatment-resistant depression. Recent methodological advances suggest that the current iTBS protocol might be improved through 1) treating patients with multiple sessions per day at optimally spaced intervals, 2) applying a higher overall pulse dose of stimulation, and 3) precision targeting of the left dorsolateral prefrontal cortex (DLPFC) to subgenual anterior cingulate cortex (sgACC) circuit. The authors examined the feasibility, tolerability, and preliminary efficacy of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), an accelerated, high-dose resting-state functional connectivity MRI (fcMRI)-guided iTBS protocol for treatment-resistant depression.

METHODS

Twenty-two participants with treatment-resistant depression received open-label SAINT. fcMRI was used to individually target the region of the left DLPFC most anticorrelated with sgACC in each participant. Fifty iTBS sessions (1,800 pulses per session, 50-minute intersession interval) were delivered as 10 daily sessions over 5 consecutive days at 90% resting motor threshold (adjusted for cortical depth). Neuropsychological testing was conducted before and after SAINT.

RESULTS

One participant withdrew, leaving a sample size of 21. Nineteen of 21 participants (90.5%) met remission criteria (defined as a score <11 on the Montgomery-Åsberg Depression Rating Scale). In the intent-to-treat analysis, 19 of 22 participants (86.4%) met remission criteria. Neuropsychological testing demonstrated no negative cognitive side effects.

CONCLUSIONS

SAINT, an accelerated, high-dose, iTBS protocol with fcMRI-guided targeting, was well tolerated and safe. Double-blinded sham-controlled trials are needed to confirm the remission rate observed in this initial study.

A-65 Verbal Abilities May Influence Performance in Assessment of Verbal Short-Term Memory Tasks

Objective

Examine whether verbal abilities may help explain the learning strategies people employ when completing a short-term verbal memory task.

Methods

The assessment records of 296 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Benton Serial Digit Learning Test – 9 Digits (SDL-9) and Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-9 was co-factored with the verbal components of the MAE to identify common sources of variance.

Results

A three-factor solution of the SDL-9 separated trials into three overlapping factors consisting of early (SDL-9_Early), middle (SDL-9_Middle), and late (SDL-9_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a four-factor model explaining 67.85% of the shared variance: 1) SenRep loaded with SDL-9_Early, 2) COWAT loaded with SDL-9_Middle and SDL-9_Late, 3) Token loaded with SDL-9_Late, and 4) Vis Nam loaded with SDL-9_Late.

Conclusions

The results suggest that individuals may engage verbal abilities differently as they progress from simpler to more difficult verbal short-term memory tasks. It appears performance in early trials is mostly associated with rote repetition and performance on middle trials is mostly associated with verbal fluency, while performance on the late trials is associated with a combination of verbal fluency, auditory comprehension, and conceptual organization/naming. This may therefore indicate a shift in learning strategy to meet increased cognitive demands.

A-49 Visual Memory Errors and Intelligence: The Role of Verbal Mediation

Objective

Examine the relationship of verbal mediation with visual memory errors and intelligence to understand the role of spoken language on other assessment measures.

Method

Assessment records were obtained from a Veteran Affairs clinic for veterans (n=100) with diverse neuropsychiatric conditions who completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Multilingual Aphasia Examination (MAE), and Benton Visual Retention Test (BVRT). A Principal Component Analysis (PCA) was used to examine the interrelationship among these assessments. The components of spoken language, types of errors on the BVRT, and the four factors of the WAIS-III were factored using the PCA to identify common sources of variance.

Results

A principal component analysis revealed a six-factor model explaining 68.16% of the shared variance among the WAIS-III factors, MAE components, and BVRT Errors. Omission errors loaded with Processing Speed and Controlled Word Association. Distortions and size errors loaded with Perceptual Organization. Size errors also loaded with Verbal Comprehension and Visual Naming. Misplacements loaded with Working Memory and Sentence Repetition. Misplacements, perseverations, and omissions loaded with the Token Test (a measure associated with auditory comprehension). Rotation errors loaded with Perceptual Organization.

Conclusions

Results indicated significant shared variance between visual memory errors, spoken language, and intelligence factors. This suggests that spoken language is involved in the process of visual memory, and deficits in spoken language may result in increased errors on visual memory tasks. Therefore, treatment recommendations for visual memory difficulties should take into consideration verbal capabilities and intelligence factors to better individualize treatment.

A-53 Exploring the Relationship between Spoken Language and Verbal Short-term Memory Assessment Tasks

Objective

Examine whether performance on spoken language assessment measures may be associated with performance at different phases of verbal learning and recall tasks.

Method

The assessment records of 222 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE), and Benton Serial Digit Learning Test – 8 Digits (SDL8). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-8 was co-factored with the spoken language components of the MAE to identify common sources of variance.

Results

A three-factor solution of the SDL8 separated trials into three overlapping factors consisting of early (SDL8_Early), middle (SDL8_Middle), and late (SDL8_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a five-factor model explaining 84.563% of the shared variance: 1) SDL8_Early loaded with SenRep, 2) SDL8_Middle loaded with SenRep, 3) SDL8_Late loaded with Token, 4) SDL8_Late loaded with COWA, and 5) VisNam alone formed the fifth factor.

Conclusions

The results suggest that rote repetition is largely associated with early trials and slightly associated with middle trials, while late trials are largely associated with auditory comprehension and slightly associated with verbal fluency. This may be indicative of a shift in use of spoken language abilities to accommodate increasing levels of complexity in presented verbal short-term memory tasks and thus reflective of a change on learning strategy to optimize performance.

A-52 An Exploratory Factor Analysis Investigation of the Role of Verbal Mediation in the Interaction between Intelligence and Visual Memory Tasks

Objective

Examine whether verbal mediation may play a role in the interaction between visual memory tasks and the four-factor model of intelligence as operationalized by standard neuropsychological assessment instruments.

Method

The assessment records of 101 American Veterans with diverse neuropsychiatric conditions were examined using Exploratory Factor and Principal Component Analyses (EFA and PCA respectively). There were no exclusion criteria. All participants completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Benton’s Visual Retention Test (BVRT), and Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using PCA. The factor solution of the BVRT was co-factored with the scales of the WAIS-III, then the resulting factor scales were again factored with the verbal components of the MAE to identify common sources of variance.

Results

A three-step analysis revealed a four-factor model explaining 69.44% of the shared variance: 1) Items 1-4 of the BVRT (BVRT-E) loaded with Verbal Comprehension and Visual Naming. 2) BVRT-E also loaded with Processing Speed and Controlled Word Association. 3) Items 5-10 of the BVRT (BVRT-L) loaded with Perceptual Organization and the Token Test. 4) Working Memory loaded with Sentence Repetition on a fourth factor.

Conclusions

The results indicate a strong relationship between assessed performance on visual memory tasks and performance on measures based on the four-factor model of intelligence. The results also appear to support the idea that verbal mediation plays a role in the interaction between visual memory and intelligence, particularly when comparing performance on simple versus more complex visual memory tasks.

Benign Multicystic Peritoneal Mesothelioma (BMPM) as a rare cause of abdominal pain in a young male: case report and review of the literature

Benign Multicystic Peritoneal Mesothelioma (BMPM) is a rare benign cystic neoplasm that arise from the peritoneum, typically found in young females (83%), with a high incidence of local recurrence after resection (almost 50% of cases). Fewer than 200 cases have been reported worldwide in 2017. Due to its rarity and the lack of a classical clinical presentation, the diagnosis pre-operatively is challenging; moreover a great part of the literature is composed of case reports and small group studies. Nowadays, guidelines are still not available, and treatment is en bloc resection of the lesion. Some authors suggest the use of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) associated with the surgical approach, even if comparative data on recurrence and complications are lacking. We report a case of BMPM diagnosed in a 40-year-old male who underwent an exploratory laparoscopy and complete excision of the neoformation. Pathology confirmed the presence of a BMPM.

The sequence of prenatal growth restraint and postnatal catch-up growth: normal heart but thicker intima-media and more pre-peritoneal fat in late infancy

BACKGROUND

The sequence of prenatal growth restraint and postnatal catch-up growth leads to a thicker intima-media and more pre-peritoneal fat by age 3-6 years.

OBJECTIVES

To study whether carotid intima-media thickness (cIMT) and pre-peritoneal fat differ already between catch-up small-for-gestational-age (SGA) infants and appropriate-for-gestational-age (AGA) controls in late infancy (ages 1 and 2 years) and whether such differences - if any - are accompanied by differences in cardiac morphology and function.

METHODS

Longitudinal assessments included body height and weight; fasting glucose, insulin, Insulin-like growth factor (IGF-I), high-molecular-weight adiponectin; body composition (by absorptiometry); cIMT, aortic IMT, pre-peritoneal fat partitioning (by ultrasound); cardiac morphometry and function (by echocardiography) in AGA and SGA infants at birth, at age 1 year (N = 87), and again at age 2 years (N = 68).

RESULTS

Catch-up SGA infants had already a thicker cIMT than AGA controls at ages 1 and 2 years, and more pre-peritoneal fat by age 2 years (all p values between <0.01 and <0.0001); all cardiac and endocrine-metabolic results were similar in AGA and SGA infants at ages 1 and 2 years.

CONCLUSIONS

From late infancy onwards, catch-up SGA infants have a thicker cIMT and more pre-peritoneal fat than AGA controls, but their cardiac morphology and function remain reassuringly similar.

[Predictive pre-treatment value of the Prognostic Nutritional Index on survival in gastric carcinoma]

BACKGROUND

The Prognostic Nutritional Index (PNI) combines the values of circulating lymphocytes and serum albumin and, in the Asian literature; it has been related with the prognosis following R0 resection of gastric cancer. No results are available in Western countries. We study the possible independent prognostic value, at the moment of the tumour's diagnosis, of PNI on survival.

PATIENTS AND METHODS

We review 234 consecutive gastric carcinomas, calculating global survival and tumour-specific survival. We considered pre-treatment PNI values of < 40 to be pathological. We carried out a univariate and multivariate analysis of cases of survival according to PNI, including the following adjustment variables: age > 70 years, ASA anaesthetic at the time of diagnosis, size of the neoplasia > 5cm, macroscopic type, undifferentiated degree and TNM clinical stage through echoendoscopy and/or CAT.

RESULTS

The univariate analysis registered greater global and specific survival in cases with PNI ≥ 40 versus PNI < 40: [HR = 2.28; CI 95% = (1.60-3.26); p< 0.001] and [HR = 2.35; CI 95% = (1.63-3.39); p< 0.001], respectively. The multivariate analysis confirmed a better independent prognosis in cases with OI ≥ 40: global survival: [HR = 1.48; CI 95% = (1.02-2.16); p = 0.040], specific survival: [HR = 1.51; CI 95% = (1.03-2.23); p = 0.036].

CONCLUSIONS

At the moment of diagnosis of gastric cancer and including all registered cases, a PNI ≥ 40 is accompanied by a signifi-cantly greater global and tumour-specific survival. In our series, this better prognosis is independent of the patient's age group, his/her ASA classification, the size and degree of differentiation of the neoplasia and its TNM clinical stage.

Imaging assessment of portal venous system: pictorial essay of normal anatomy, anatomic variants and congenital anomalies

The purpose of this pictorial essay is to describe anatomic variants and congenital anomalies of portal venous system and related liver parenchymal alterations. The imaging findings of some of these entities have been previously described in other articles, however this work encompasses all congenital anomalies of portal venous system with attention to their features on various imaging modalities; in particular we illustrated with detailed pictures all the main portal vein variants, congenital extra- and intra-hepatic porto-systemic venous shunts and portal vein aneurysm. Variants of portal branches and intrahepatic portosystemic shunts are quite uncommon, however, when present, they should be recognized before performing surgery or interventional procedures. Congenital absence of the portal vein is an important finding as the complete loss of portal perfusion predisposes the liver to focal or diffuse hyperplastic or dysplastic changes. Portal vein aneurysm is a rare clinical entity that can affect intra- and extra-hepatic portal branches; although usually asymptomatic, thrombosis can occur. Awareness of congenital variants of portal venous system among radiologists should allow a more confident diagnosis and permit an accurate planning of surgical procedures and percutaneous interventions; identification of portal system anomalies also suggest an accurate evaluation of associated hepatic parenchymal anomalies such as nodular regenerative hyperplasia, focal nodular hyperplasia (FNH), and adenomas with high risk of malignant transformation.

Screening for Atrial Fibrillation

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

[Relation between preoperative prognostic Onodera's Index and postsurgery complications in the R0 gastric carcinoma resection]

BACKGROUND

It has been postulated in the Asian literature that a low prognostic nutritional index (OI) could be associated with a higher rate of complications following radical gastric cancer surgery, but there is a lack of data concerning western countries. The aim is to analyze the relationship between a low preoperative OI and the frequency and severity of surgical complications in R0 gastric cancer resection.

PATIENTS AND METHODS

In the present article, 124 cases of gastric cancer with R0 resection were reviewed. An OI <45 was considered pathologically low. The complication rate was compared between both groups: OI <45 vs OI =45. A multivariate analysis was performed adjusting for: age > 68 years, ASA score, preoperative hemoglobin level <12 g/dL, pTNM stage, administration of neoadyuvant therapy and type of gastrectomy. The relationship between a PNI<45 and the severity of complications graded according to the Clavien-Dindo classification was determined.

RESULTS

We registered mild complications in 11.3% of cases, severe complications in 9.7% and a mortality rate of 2.4%. Patients with a OI <45 showed a higher complication rate: 37.7% versus 12.7% [odds ratio (OR) = 4.17; CI95% = (1.71 - 10.20 p = 0.001)], confirmed by multivariate analysis: [OR = 4.17; CI95% = (1.54 - 11.30); p = 0.005]. Patients with OI <45 had more severe complication-exitus: 20.8% versus 5.6% [OR = 4.39; CI95% = (1.31 - 14.68); p = 0.011].

CONCLUSIONS

We confirmed that patients with a low preoperative OI show a higher independent risk of complications after a R0 gastric cancer resection in a western country as well. Complications, in these cases with OI <45, registered a significantly higher severity grade.

A peculiar case of diffuse hemangiomatosis of the left hepatic lobe in an asymptomatic adult patient: case report and literature review

We report a rare case of diffuse hepatic hemangiomatosis (DHH) of the left hepatic lobe coexistent with giant hepatic hemangioma and without extra-hepatic involvement in an asymptomatic adult patient. Liver hemangiomas are the most common benign liver tumors. However, DHH without extra-hepatic involvement has rarely been reported in adults. Furthermore, giant hepatic hemangioma coexistent with DHH is even uncommon, although an association between hemangiomatosis and giant hepatic hemangiomas may be supposed. In this peculiar case, we observed an exclusive and widespread involvement of the left hepatic lobe with a sharp boundary between normal and altered liver parenchyma running along Cantlie's line.

Channel interpolation in TMS-EEG: a quantitative study towards an accurate topographical representation

The co-registration of transcranial magnetic stimulation and electroencephalography (TMS-EEG) is emerging as a successful technique for causally exploring cortical mechanisms and connections. However, various artefacts could affect TMS-EEG signals. Correct artefacted channels reconstruction is crucial to obtain accurate topographical representation and consequently accurate inverse problem solution, in order to map in a proper way the global brain responses after the stimulation of one particular brain region of interest. In this paper, we discuss the problem of artefacted channels interpolation in TMS-EEG signals. Aim of the study was to investigate two different interpolation methods evaluating their performance in two datasets: one constituted by 19 EEG channels montage (low-density spatial resolution) and the other one by 60 EEG channels montage (high-density spatial resolution). In addition, these evaluations took place in two different contexts of application: after the averaging of TMS Evoked Potentials (TEPs) in a time interval to obtain a global information in the considered range, and at fixed latencies 100 ms and 300 ms after the TMS stimulus. The results showed that the global reconstruction error was lower at fixed latencies for the high-density electrodes spatial resolution montage.

European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

Abstract

Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence.

Key Points

• This report provides guidelines for MRI in endometriosis.

• Minimal and optimal MRI acquisition protocols are provided.

• Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria.

Electronic supplementary material

The online version of this article (doi:10.1007/s00330-016-4673-z) contains supplementary material, which is available to authorized users.

EL PROMISORIO CAMINO DE LA TECNOLOGÍA CRISPR-CAS9 EN LA EDICIÓN GENÓMICA

CRISPR, grupo de repeticiones cortas palindrómicas regularmente espaciadas (clustered regularly interspaced short palindromicrepeat), es un sistema de defensa viral encontrado en el genoma de bacterias y arqueas. La transcripción de estas secuencias CRISPR, que portan ADN viral asimilado previamente (espaciadores), produce crARNs que, en complejo con complejos  multiproteicos asociados a CRISPR, Cas (CRISPR associated), catalizan la degradación de material genético invasor que porte secuencias complementarias a los crARNs (protoespaciadores). En Streptococcus pyogenes, Cas9 en la única proteína encargada de efectuar los cortes de doble hebra en el ADN extraño, proporcionando un sistema in vitro e in vivo rápido, simple y barato para introducir cortes y mutaciones en cualquier región deseada, en tanto Cas9 sea programada con un crARN específico, llamado específicamente gARN, sgARN o chiARN. La tecnología CRISPR-Cas9 puede aplicarse eficientemente a una gran variedad de organismos procariotas y eucariotas, es decir, constituye una herramienta de inestimable poder en la edición genómica y estudio de la función de los genes. 

DETERMINACIÓN DE GÉNEROS BACTERIANOS EN EL MAR DE LA PLAYA CANTOLAO – LA PUNTA – CALLAO

Los océanos albergan una gran diversidad biológica, hasta el momento relativamente poco explorada por el humano. Con el objetivo de ampliar los conocimientos en la biodiversidad bacteriana del mar peruano, se realizaron muestreos aleatorios en el mar de Playa Cantolao-La Punta-Callao (12º04´06´´ S 77º10´10´´O), en total se tomaron 5 muestras en frascos estériles a una profundidad de 3 m utilizando una vara de madera acondicionada a una jeringa de 20 ml. Para el aislamiento se utilizó el método de dispersión en placa en Agar Marino, se trabajó con diluciones sucesivas para obtener colonias aisladas. Para la identificación se realizaron pruebas bioquímicas que incluían determinación de citocromo oxidasa, motilidad, producción de H2S, producción de indol, metabolismo de glucosa, producción de pigmento, luminiscencia, catalasa y desarrollo en anaerobiosis; además de las coloraciones Gram y de espora. Los esquemas propuestos por Das S et al. (2007), Oliver J (1982) y el Bergey´s Manual 2da y 7ma edición fueron utilizados para la determinación de géneros. Se logró el aislamiento de 20 cepas bacterianas. Los géneros encontrados fueron: Moraxella, Bacillus, Acinetobacter, Vibrio, Aeromonas, Photobacterium, Alteromonas, Alcaligenes, Streptococcus y Chromobacterium. 

Stroop Color-Word Interference Test: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data on the Stroop Test across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the Stroop Test, as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models explained 14-36% of the variance in Stroop Word scores, 12-41% of the variance in the Stoop Color, 14-36% of the variance in the Stroop Word-Color scores, and 4-15% of variance in Stroop Interference scores. Although t-tests showed significant differences between men and women on the Stroop test, none of the countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

This is the first normative multicenter study conducted in Latin America to create norms for the Stoop Test in a Spanish-Speaking sample. This study will therefore have important implications for the future of neuropsychology research and practice throughout the region.

Acute and chronic malnutrition and their predictors in children aged 0-5 years in São Tomé: a cross-sectional, population-based study

OBJECTIVE

Undernutrition is an important cause of morbidity and mortality in infants and children worldwide. The aim of this study was to evaluate the nutritional status and their predictors in children from 0 to 5 years of age in São Tomé.

STUDY DESIGN

A cross-sectional study was conducted in São Tomé Island.

METHODS

A total of 1285 individuals were enrolled between January and May 2011. Children were measured, and height for age (HAZ), weight for height (WHZ) and body mass index (BAZ) Z-score were computed. Global acute undernutrition is defined as weight for height <-1 Z-score (wasting < -2 Z-scores) and global chronic undernutrition as length/height for age <-1 Z-score (stunting < -2 Z-scores). Relevant information was collected from individual health bulletins, namely gestational age and birth weight, as well as weight at 6, 12, 18 and 24 months for all individual above these ages. Mothers were invited to answer a specific questionnaire.

RESULTS

A high percentage of global acute undernutrition (30.9% in <24 months and 21.9% in ≥24 months) and global chronic undernutrition (32.5% in <24 months and 41.1% in ≥24 months) was observed. Appropriate birth weight for gestational age (AGA) is significantly associated with lower odds for both acute (OR 0.485 [95% CI 0.299-0.785]) and chronic undernutrition (OR 0.427 [95% CI 0.270-0.675]) in children >12 months. Weight gain above 0.67 Z-score in the first semester of life was strongly related to lower odds for both acute (OR 0.109 [95% CI 0.040-0.291]) and chronic undernutrition (OR 0.379 [95% CI 0.187-0.770]) in children >12 months of age. Similarly, mother's education seems to protect against acute (>12 months: OR 0.448 [95% CI 0.244-0.825]; >24 months: OR 0.186 [95% CI 0.064-0.540]) and chronic undernutrition (>12 months: OR 0.389 [95% CI 0.232-0.653]; >24 months: OR 0.324 [95% CI 0.171-0.625]). All logistic regressions were adjusted for all children (gender, age, gestational age, birth weight, breastfeeding, begin consumption alcohol), mothers (age, height, body mass index, educational level, number of previous pregnancies, smoking during pregnancy, alcohol consumption during pregnancy) and household (number of siblings and persons at home) variables included in the protocol.

CONCLUSIONS

Birth weight, nutritional status, and the mother's education and weight gain particularly in the first year of life were important factors protecting against undernutrition during infancy and childhood. These results emphasize the importance of women's nutrition and of adequate birth weight and particularly weight gain during the first year of life in order to prevent wasting and stunting in childhood.

A pilot study of nurse-led, home monitoring for patients with chronic respiratory failure and with mechanical ventilation assistance

We assessed the feasibility of telemedicine for home monitoring of 45 patients with chronic respiratory failure (CRF) discharged from hospital. The patients transmitted pulsed arterial saturation (pSat) data via a telephone modem to a receiving station where a nurse was available for a teleconsultation. A respiratory physician was also available. Scheduled and ad hoc appointments were conducted. Thirty-five patients were on home mechanical ventilation, 13 with invasive and 22 with non-invasive devices. The main diagnosis was chronic obstructive pulmonary disease (COPD). The follow-up period was 176 days (SD 69). In all, 376 calls for scheduled consultations were received and 83 ad hoc consultations were requested by the patients. The actions taken were: 55 therapy modifications, 19 hospitalizations in a respiratory department for decompensated CRF, three hospitalizations in an intensive care unit (ICU), 22 requests for further investigations, 25 contacts with the general practitioner (GP), 66 demands for respiratory consultations and 10 calls for the emergency department. The mean time recorded for the 459 calls was 16 min/patient/week. In 82% of calls, a pSat recording was received successfully. The nurse time required to train the users in the operation of the pSat instrument was high (mean time 30 min). However, the results showed that home monitoring was feasible, and useful for titration of oxygen, mechanical ventilation setting and stabilization of relapses.

An update on clinical applications of hepatospecific contrast media in magnetic resonance imaging of liver parenchyma

Hepatobiliary-specific contrast agents are now widely used in magnetic resonance imaging (MRI) of liver parenchyma. As extracellular fluid agents, they provide informations regarding lesion vascularity and their use in the hepatobiliary or delayed phase (DPI), and give additional data regarding hepatocyte presence and function. The aim of this article is to review the recent literature about MRI using hepatobiliary-specific contrast agents and to discuss benefits and limits of their clinical applications. Since November 2008, hepatobiliary contrast agents were routinely employed in our Institution for the characterization of equivocal liver lesions detected by other imaging modalities, and for the evaluation of hepatic nodules in liver cirrhosis. The informations provided are particularly relevant for the detection of metastases, for the differentiation between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), and for the detection and differentiation between dysplastic nodules (DNs) and hepatocellular carcinoma (HCC) in the cirrhotic liver. The role in the cirrhosis grading and the quantification of liver function is still controversial. Finally, their biliary excretion allows evaluation of anatomy and function of the biliary tree. According to our and reported data, hepatobiliary contrast agents are able to improve liver lesions detection and characterization; their introduction in clinical practice has improved MRI diagnostic efficacy/accuracy, allowing to decrease the number of invasive diagnostic procedures.

Pertinent parameters in photo-generation of electrons: Comparative study of anatase-based nano-TiO2 suspensions

In the field of solar fuel cells, the development of efficient photo-converting semiconductors remains a major challenge. A rational analysis of experimental photocatalytic results obtained with material in colloïdal suspensions is needed to access fundamental knowledge required to improve the design and properties of new materials. In this study, a simple system electron donor/nano-TiO2 is considered and examined via spin scavenging electron paramagnetic resonance as well as a panel of analytical techniques (composition, optical spectroscopy and dynamic light scattering) for selected type of nano-TiO2. Independent variables (pH, electron donor concentration and TiO2 amount) have been varied and interdependent variables (aggregate size, aggregate surface vs. volume and acid/base groups distribution) are discussed. This work shows that reliable understanding involves thoughtful combination of interdependent parameters, whereas the specific surface area seems not a pertinent parameter. The conclusion emphasizes the difficulty to identify the key features of the mechanisms governing photocatalytic properties in nano-TiO2.